Provider Demographics
NPI:1427298488
Name:GROSSEN-MAYER, ANITA C (LPT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:C
Last Name:GROSSEN-MAYER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 NE 53RD CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6058
Mailing Address - Country:US
Mailing Address - Phone:503-648-6832
Mailing Address - Fax:503-648-6832
Practice Address - Street 1:1742 NE 53RD CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6058
Practice Address - Country:US
Practice Address - Phone:503-648-6832
Practice Address - Fax:503-648-6832
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1455225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR133618Medicare UPIN
OR133618Medicare PIN